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National Trends in Immediate Breast Reconstruction: An Analysis of Implant-Based Versus Autologous Reconstruction After Mastectomy

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Many factors affect access to immediate breast reconstruction (IR) after mastectomy. The present study was performed to assess trends, outcomes, and predictors of IR techniques using a nationally representative cohort.

Methods

The 2009–2014 National Inpatient Sample (NIS) was used to identify adult women who underwent inpatient mastectomy with IR. Patients were compared by type of reconstruction: implant-based IR versus autologous reconstruction (AR). AR was classified as a microsurgical or pedicled flap procedure. Incidence, outcomes, and predictors were assessed using Chi squared univariate tests and multivariable logistic regression analyses.

Results

Of 194,073 women who underwent IR, 136,668 (70.4%) received implant-based IR and 57,405 (29.6%) received AR. Of those who underwent AR procedures, 31,336 (54.6%) received microsurgical flaps and 26,680 (46.5%) received pedicled flaps. Utilization of deep inferior epigastric perforator (DIEP) flaps increased significantly (28.6–42.5% of AR, P < 0.001). Predictors of AR were Black race [adjusted odds ratio (AOR) = 1.46, P < 0.001], lower Elixhauser Comorbidity Index (AOR = 1.25, P < 0.001), private insurance (AOR = 1.07, P = 0.030), body mass index (BMI) ≥ 30 kg/m2 (AOR = 1.38, P < 0.001), urban teaching hospital designation (AOR = 1.77, P < 0.001), and high hospital volume (AOR = 3.11, P < 0.001). Similar factors were associated with the use of microsurgical flaps. AR and microsurgical flaps were associated with higher rates of acute inpatient complications, resource utilization and length of stay (LOS) compared with implant-based IR and pedicled flaps, respectively.

Conclusion

Implant-based IR remains the most common type of IR, although rates of microsurgical AR are on the rise. Follow-up of complications, costs, and quality-of-life measures may show that AR provides long-term high-value care despite upfront morbidity, cost, and use of hospital resources.

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Authors and Affiliations

  1. Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA

    Ava D. Mandelbaum BA & Peyman Benharash MD

  2. Division of General Surgery, Department of Surgery, University of California, Los Angeles, CA, USA

    Carlie K. Thompson MD, Deanna J. Attai MD, Jennifer L. Baker MD, Maggie L. DiNome MD, Peyman Benharash MD & Minna K. Lee MD

  3. Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, Los Angeles, CA, USA

    Ginger Slack MD

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  1. Ava D. Mandelbaum BA
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  2. Carlie K. Thompson MD
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Correspondence to Minna K. Lee MD.

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Mandelbaum, A.D., Thompson, C.K., Attai, D.J. et al. National Trends in Immediate Breast Reconstruction: An Analysis of Implant-Based Versus Autologous Reconstruction After Mastectomy. Ann Surg Oncol 27, 4777–4785 (2020). https://doi.org/10.1245/s10434-020-08903-x

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  • DOI: https://doi.org/10.1245/s10434-020-08903-x

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